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General NPI Number Information
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NPI Number | 1124477963
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Entity Type | Organization
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Legal Business Name | CO-CREATIVE COACHING, LLC
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Dates
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Enumeration Date | 06/11/2016
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Last Update Date | 06/11/2016
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Provider Practice Location Address
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Address Line | 660 LINTON BLVD 203-A
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City | DELRAY BEACH
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State | FL
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Zip | 33444-8167
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Country | US
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Telephone | 561-285-2052
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Fax |
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Provider Business Mailing Address
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Address Line | 13900 JOG RD STE 262
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City | DELRAY BEACH
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State | FL
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Zip | 33446-5905
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Country | US
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Telephone | 561-285-2052
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Fax |
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Authorized Official
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Title or Position | MMGR/OWNER
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Name | MS. JANUS MONCUR
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Credential | LCSW
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Telephone | 561-285-2052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | SW13546
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | SW13546
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | SW13546
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | SW13546
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | SW13546
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License Number State | FL
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